Doctor's Stuff

Here's a little insight for all the doctors who might read this, in particular, the Amersham Vale gang.

Well, its a bit like putting into practice everything I've ever learnt from medical school through to general practice training. I am the sole doctor for the 12 bed hospital - but it usually keeps in only 5 or so patients at a time. In addition, there is a daily outpatients clinic, first come, first served. So its primary and secondary care all by the same doctor.

The hospital tends to get alot of children with D&V and pneumonia, plus the occasional septic arthritis. There's A&E type work too, especially on payday when everyone gets drunk on high wine (a poisonous blend of distilled rice and sugar which seems to have a similar mood altering effect as say crack cocaine) and beats each other up. There is an unexpectedly high number of abscesses - face, shin, finger - so lots of I&D, which I hadn't done for quite a while.

Not much tropical medicine though. I haven't seen a single case of Malaria, perhaps due to the strength of the bed net programme. Lots of TB - and there's a well organised team of DOTS workers who manage that.

Primary Care: there's a lot of hypertension and diabetes, and a lot of headache and "weak weak doctor" which may sound familiar to South London GP's. Depression is not a recognised diagnosis, which is reflected in the drug cupboard: just an unopened old pack of Amitriptytlline.

In fact, the drugs supply is very good for such a remote hospital in a relatively impoverished area. The only glaring absences are statins (only available in the capital Georgetown), Mefenamic Acid and ear drops for otitis externa.

The personnel problems are dire. No Guyanese doctor will work here. About 50% of the Guyanese population live in Georgetown, and it appears that very few ever go to the regions. This government has initiated a big training scheme, with over 60 medical students from the regions - meaning largely Amerindians - currently training in Cuba, and it is hoped that some of these will want to return to the regions. But until that results in more doctors on the ground, the government have gone for a dual solution: import Doctors from Cuba and train up "Medex's". These are like super-nurses, with similar prescribing rights to doctors and plenty of experience, but less formal training. They are the backbone of the country's health system.

Unfortunately, the Cubans don't tend to last long. In Mabaruma they seem to get sick, go to Georgetown and never appear again. Having seen the conditions in which they work, I don't blame them. Its hard enough working in a new culture, not to mention a new language (their English is invariably abysmal, and Creole takes some getting used to even as a native English speaker) but on top of that they are on call 24/7. Not to mention the distress of the frequent deaths of young children, which is unfortunately not a rare occurrence, often due to the long distances they travel to hospital whilst seriously sick.

In addition to Medex's and Cuban doctors, each village has a local Community Health worker. Highly knowledgable about their communities, these workers have quite limited prescription powers, and work directly in the villages, referring people to hospital when necessary - though unfortunately not always in time to help.

So its the Medex's and the CHO's that I will be working with for the rest of my stay - some of this has begun already, and I hope will be a means by which my presence here achieves more than just patching up drunk boys on payday.... Fingers crossed!